Atypical Ductal Hyperplasia at Margin of Breast Biopsy—Is Re-Excision Indicated?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Atypical duct hyperplasia (ADH) observed during core needle biopsy is associated with a high rate of cancer upon excision. Controversy exists regarding the need to re-excise ADH involving a margin. The purpose of this study was to determine the rate of residual pathology in patients that underwent re-excision for ADH involving the margin.
In a retrospective review of the pathology database from 1 January 2000 to 1 June 2006, we identified 44 lumpectomy specimens with ADH involving the margin; 24 patients (55%) had a re-excision. Slides were reviewed to verify the diagnosis of ADH near the margin and the presence of residual disease on re-excision associated with the biopsy cavity.
Patients had pure ADH (15, 63%), ADH and ductal carcinoma in situ (DCIS) (7, 29%) or ADH with invasive carcinoma (2, 8%). Residual ADH or cancer was found in 14 of 24 patients (58%). Of 15 patients with pure ADH, 6 (40%) had residual pathology: ADH (2), DCIS (2) and invasive carcinoma (2). In this group, 27% of patients were reassessed as having DCIS or invasive carcinoma. Of the 9 patients with cancer, 8 (89%) had residual disease in the form of ADH (4) or DCIS (4).
ADH found at the margin of a lumpectomy specimen is associated with a high rate of residual ADH and cancer. Over one quarter of the patients with an initial diagnosis of ADH were reassessed as having DCIS or invasive carcinoma. Re-excision in all patients with ADH involving the margin is recommended.
- Page DL, Dupont WD. Anatomic markers of human premalignancy and risk of breast cancer. Cancer 1990; 66:1326–35 CrossRef
- Sewell CW. Pathology of high-risk breast lesions and ductal carcinoma in situ. Radiol Clin North Am 2004; 42:821–30 CrossRef
- Houssami N, Ciatto S, Ellis I, Ambrogetti D. Underestimation of malignancy of breast core-needle biopsy. Cancer 2007; 109:487–95 CrossRef
- Greene T, Tartter PI, Rosenbaum Smith S, Estabrook A. The significance of surgical margins for patients with atypical ductal hyperplasia. Am J Surg 2006; 192:499–501 CrossRef
- Goldstein NS, Lacerna M, Vicini F. Cancerization of lobules and atypical ductal hyperplasia adjacent to ductal carcinoma in situ of the breast. Significance for breast-conserving therapy. Am J Clin Pathol 1998; 110:357–67
- Page DL, Rogers LW. Combined histologic and cytologic criteria for the diagnosis of mammary atypical ductal hyperplasia. Hum Pathol 1992; 23:1095–7 CrossRef
- Tavassoli FA, Norris HJ. A comparison of the results of long-term follow-up for atypical intraductal hyperplasia and intraductal hyperplasia of the breast. Cancer 1990; 65:518–29 CrossRef
- Page DL, Dupont WD, Rogers LW, Rados MS. Atypical hyperplastic lesions of the female breast. A long-term follow-up study. Cancer 1985; 55:2698–708 CrossRef
- Ghofrani M, Tapia B, Tavassoli FA. Discrepancies in the diagnosis of intraductal proliferative lesions of the breast and its management implications: results of a multinational survey. Virchows Arch 2006; 449:609–16 CrossRef
- Neuschatz AC, DiPetrillo T, Steinhoff M, Safaii H, et al. The value of breast lumpectomy margin assessment as a predictor of residual tumor burden in ductal carcinoma in situ of the breast. Cancer 2002; 94(7):1917–24 CrossRef
- Wazer DE, Schmidt-Ullrich RK, Schmid CH, Ruthazer R, et al. The value of breast lumpectomy margin assessment as a predictor of residual tumor burden. Int J Radiat Oncol Biol Phys 1997; 38(2):291–9
- Atypical Ductal Hyperplasia at Margin of Breast Biopsy—Is Re-Excision Indicated?
Annals of Surgical Oncology
Volume 15, Issue 3 , pp 843-847
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Atypical duct hyperplasia
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, Mount Sinai Medical Center, New York, NY, USA
- 2. Department of Surgery, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY, 11373, USA
- 3. Department of Pathology, Mount Sinai Medical Center, New York, NY, USA